UH Cancer Center hotline: modern medicine and the road to prevention: a long and tortuous path.

Traditionally medical education and the practice of medicine have focused on the treatment and cure of disease with considerably less attention devoted to the prevention of the chronic diseases of aging. With ongoing discoveries in basic mechanisms of biochemistry, physiology, nutrition, and molecular biology there is a growing sense that the onset of many of the inevitable diseases of aging may be signifi cantly delayed and reduced in intensity. This has prompted the development of clinical prevention studies to test the effi cacy of various prevention approaches to a variety of important diseases such as cardiovascular disease and cancer. Regrettably recent highly publicized failures of many of these trials has jeopardized future trials and thrown the concept of prevention into serious disarray. In particular the failure of the Selenium and Vitamin E Cancer Prevention Trial, (SELECT),1 to demonstrate a reduction of prostate cancer incidence (indeed a signifi cant increase in prostate cancer was observed for the vitamin E arm) after spending over $100,000,000 has signifi cantly impugned the role of vitamin E and selenium in human disease prevention and will severely impede future trials of these agents and others. A closer look at these trials, their underlying philosophical and biochemical bases, and their implications reveals many inadequacies in the current practice of preventive medicine research, and suggests why they may have failed, as well as providing a blueprint for the design of future trials.